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LUNG AND PLEURAL CANCER



Lung cancer
The two main types of lung cancer are non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Most cases of lung cancer are caused by tobacco smoking. In recent years, improvements in terms of progression-free survival have been achieved in NSCLC with the use of targeted therapies.
 
Pleural cancer
Malignant mesothelioma forms malignant (cancerous) cells in the thin layer of tissue that covers the lung, chest wall or abdomen. The most common type is epithelial mesothelioma. The most common cause is prolonged exposure to asbestos.

 
Our goal is to achieve the best personalized treatment for lung and pleural cancer according to the genetic characteristics of each patient’s tumor.

SYMPTOMS of lung and pleural cancer
Lung or pleural cancers frequently do not cause any obvious symptoms and are often detected by chest x-ray performed for other conditions. Lung or pleural cancer may cause the following symptoms:
  • Discomfort or pain in the chest.
  • Persistent or worsening cough.
  • Difficulty breathing.
  • Whistle when breathing.
  • Blood in the sputum (mucus expelled from the lungs).
  • Hoarseness of voice.
  • Loss of appetite.
  • Unexplained weight loss.
  • Extreme tiredness.
  • Difficulty swallowing.
  • Swelling of the face or veins in the neck.

DIAGNOSTIC TESTS to detect lung and pleural cancer
The following tests and procedures may be used in conjunction to detect lung or pleural cancer:
  • Physical examination and review of medical records.
  • Laboratory tests.
  • Chest X-ray.
  • Computerized tomography scan (CAT).
  • Sputum cytology.
  • Fine needle aspiration biopsy of the lungs (FNAB).
  • Bronchoscopy.
  • Thoracoscopy.
  • Thoracentesis.
  • Optical or electron microscopy.
  • Immunohistochemistry (IHC).

TREATMENTS for lung and pleural cancer
Different types of treatment are available for lung cancer, depending on the subtype. Ten types of standard treatment exist: surgery, radiotherapy, chemotherapy, targeted therapy, laser therapy, photodynamic therapy (PDT), cryosurgery, electrocautery, careful observation, insertion of an endoprosthesis.

Different types of treatment are being investigated in clinical trials.

IMMUNOTHERAPY for lung cancer
Despite recent advances in treatment of other types of cancer with immunotherapy, until recently lung cancer was considered an immuno-resistant tumor. However, recently Opdivo® was approved for treatment of certain subtypes of lung cancer.

PERSONALIZED TREATMENT for non-small-cell lung cancer (NSCLC)
NSCLC can be classified into different subtypes according to the genetic alterations that drive tumor growth. For two of those genetic alterations, highly effective oral drugs are available:

• Firstly, mutations in the EGFR gene predict response to targeted therapy with drugs that inhibit tyrosine kinase of EGFR (Iressa® / Taceva®). Several studies (including the EURTAC trial designed by Dr. Rafael Rosell) have shown that NSCLC patients with EGFR mutations in tumor tissue have better survival and good quality of life with these treatments.

• Secondly, between 2-7% of NSCLC patients have a genetic alteration consisting of a reorganization and fusion of two fragments of chromosome 2 (ALK and EML4). Treatment with the oral drug Crizotinib® inhibits this alteration, prolonging survival for these patients.

These orally-administered drugs are highly specific and with less side effects than conventional chemotherapy.